Modifier Coding Alert
Accept That Modifier 51 Isn't Appropriate With CMT Codes
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Question: What modifier would I report for a patient who had a CMT (98940-98943) for three vertebrae? Is modifier 51 correct?
Rhode Island Subscriber
Answer: Modifier 51 (Multiple procedures) is not appropriate for these codes as they already have a multiplier incorporated into their descriptors. Code 98940 (Chiropractic manipulative treatment [CMT]; spinal, 1-2 regions) is for 1-2 regions and then the number of regions increases from there. You should only use one code as the code descriptors illustrate:98941 (… 3-4 regions), 98942 (… 5 regions), and 98943 (… extraspinal, 1 or more regions).You shouldn’t use a modifier.
CMT codes are based on the regions treated, not the number of vertebrae. So if three vertebrae in two regions are treated, 98940 is the correct code and you don’t need a modifier.
Tip: When reporting CMT codes, remember to only report the code once when a physician performs manipulation on more than one vertebra of the same spinal region.
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